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Medical - Kaiser
Medical coverage provides you with benefits that help keep you healthy like preventive care screenings and access
to urgent care. It also provides important financial protection if you have a serious medical condition.
College of Marin provides you with comprehensive coverage through Kaiser Permanente and Blue Shield of
California. The following are brief benefit summaries. Please review the Summary of Benefits and Coverage and
Evidence of Coverage on
http://www.marin.edu/HR/enrollment.htmlKaiser Medical
Traditional HMO Plan
Kaiser Medical
Deductible HMO
In-Network
In-Network
Annual Deductible
Individual
Family
$0
$0
$1,000
$2,000
Annual Out-of-Pocket Max
Individual
Family
$1,500
$3,000
$3,000
$6,000
Lifetime Max
Unlimited
Unlimited
Office Visit
Primary Provider
$20 copay
$20 copay
1
Specialist
$20 copay
$20 copay
1
Preventive Services
Plan pays 100%
Plan pays 100%
Acupuncture
Chiropractic Care
$10 copay
(up to 30 visits per year)
$10 copay
1
(up to 30 visits per year)
Lab and X-ray
Plan pays 100%
Plan pays 100% for Preventive
All other:
$10 copay per encounter
1
Complex imaging: $50 copay per
procedure
1
Inpatient Hospitalization
Plan pays 100%
Plan pays 80% after deductible
Outpatient Surgery
$20 copay per procedure
Plan pays 80% after deductible
Urgent Care
$20 copay
$20 copay
1
Emergency Room
$100 copay per visit
(copay waived if admitted)
Plan pays 80% after deductible
Ambulance (Ground or Air)
$50 copay
$150 copay
1
Not subject to deductible
The information in this booklet is a general outline of the benefits offered under College of Marin benefits program. This booklet may not include all relevant limitations and conditions.
Specific details and limitations are provided in the plan documents, which may include a Summary of Plan Description (SPD), Evidence of Coverage (EOC), and/or insurance policies. The
plan documents contain relevant plan provisions. If the information in this booklet differs from the plan documents, the plan documents will prevail.